Patients with coronary heart disease should be careful about several types of angina pectoris when taking medication

A friend with coronary heart disease asked Huazi that he occasionally had angina pectoris and was very scared. Would it be dangerous? How should he be treated? Huazi said that coronary heart disease is a common heart disease among the middle-aged and elderly. The cause of the disease is atherosclerosis of the coronary arteries. The hardened plaques cause arterial stenosis and poor blood flow, which affects the blood supply to the heart, causing myocardial cells to be ischemic and hypoxic, thus leading to angina pectoris.

1. The impact of coronary artery stenosis on the heart The human heart is a muscular organ that is responsible for pumping blood and consumes nutrients and oxygen. The coronary arteries on the heart are the blood vessels responsible for supplying nutrients and oxygen to the heart. However, under the influence of factors such as hypertension, hyperlipidemia, diabetes, and smoking, the coronary arteries will develop atherosclerosis and the arterial lumen will become narrow.

When the degree of coronary artery stenosis is less than 50%, it generally does not affect the blood supply to the heart and no symptoms occur; when the degree of stenosis is between 50% and 70%, it does not affect the blood supply to the heart at rest, but insufficient blood supply and angina pectoris will occur during activity, but angina pectoris can be prevented and treated with drugs. When the degree of stenosis exceeds 70%, the effect of drugs is weakened, and stents or bypass surgery are needed to effectively relieve the symptoms of myocardial ischemia.

2. Drug treatment of coronary heart disease Drug treatment of coronary heart disease needs to achieve two points at the same time. First, delay the progression of the disease, reduce the risk, and prevent myocardial infarction. Second, relieve symptoms, reduce the onset of angina pectoris, and improve the patient's quality of life.

Drugs used to slow down the progression of the disease and reduce the risk of disease:

1. Use statins: reduce the level of low-density lipoprotein cholesterol (LDL-C) to below 1.8mmol/L. It can delay the progression of plaques, increase the stability of plaques, and prevent plaque rupture. After long-term use, it is possible to reverse plaques, reduce the size of plaques, and improve the degree of coronary artery stenosis.

2. Use antiplatelet drugs: inhibit platelet activity, inhibit platelet aggregation when plaque ruptures, and prevent the formation of blood clots.

3. Use "pril" or "sartan": it can inhibit the renin-angiotensin-aldosterone system (RAAS), lower blood pressure, reduce cardiac load, improve ventricular remodeling, and reverse left ventricular hypertrophy.

4. Trimetazidine: Promotes the energy metabolism of cardiomyocytes under hypoxic conditions and protects cardiomyocytes.

Drugs to relieve symptoms and reduce angina attacks:

1. Lolamine drugs: can inhibit cardiac excitability, reduce heart rate (need to drop to 55-60 per minute), weaken myocardial contractility, reduce cardiac oxygen consumption, reduce angina attacks, and increase patients' exercise tolerance.

2. Calcium channel blockers: They can slow down the heart rate, weaken myocardial contractility, lower blood pressure, reduce the workload on the heart, and dilate coronary arteries to relieve coronary artery spasm.

3. Nitrate drugs: dilate coronary arteries, dilate small arteries and small veins, reduce the heart's preload and afterload, and eliminate angina symptoms.

4. Ivabradine: blocks the electrical signals of the sinoatrial node, lowers the heart rate, and reduces myocardial oxygen consumption.

3. What kind of chest pain is dangerous? Most patients with coronary heart disease will experience stable angina pectoris, also known as exertional angina pectoris. This means that angina pectoris will occur after an activity, but will be relieved within ten minutes after rest. If the activity is repeated, the angina pectoris will recur. The degree of danger of stable angina pectoris is not high, and it can be prevented by taking medicine and avoiding fatigue.

The danger of coronary heart disease lies in the instability of plaques in the coronary arteries, which may rupture and induce platelets to aggregate and form blood clots, blocking the coronary arteries and causing myocardial infarction.

There are several types of unstable angina that require special attention.

1. Initial angina pectoris: This means that there is no angina pectoris symptoms before. Within one month after the first attack of angina pectoris, there is about a 10% chance of myocardial infarction.

2. Worsening angina: It refers to the originally stable angina pectoris, but the frequency of attacks suddenly increases, the severity of angina pectoris worsens, and the duration is prolonged, which means that the disease is progressing.

3. Post-infarction angina pectoris: If an acute myocardial infarction occurs and angina pectoris recurs within one month, it is possible that other blood vessels are still narrowed and another infarction may occur.

4. Variant angina pectoris: Angina pectoris occurs at rest, often in the second half of the night when sleeping, regardless of the amount of activity. It is caused by coronary artery spasm and contraction, resulting in temporary myocardial ischemia. Coronary artery spasm is the main cause of plaque rupture.

5. Intermediate syndrome: Angina pectoris lasts for more than 15 minutes at rest, which means that the plaque may have ruptured and myocardial infarction is likely to occur.

When the above-mentioned unstable angina occurs, the patient should rest in a semi-recumbent position and call "120" for rescue immediately. It is not recommended to take medication on your own before the diagnosis is confirmed. After 120 arrives, go to the nearest hospital with interventional treatment. Use thrombolysis or stenting as soon as possible to reopen the blood vessels and restore blood supply to the heart.

In summary, people with coronary heart disease need to take medication regularly under the guidance of a doctor to delay the progression of the disease and prevent angina and myocardial infarction. If it is stable angina, the danger is not great. What you need to be wary of is unstable angina. Once it occurs, call 120 immediately and seek medical treatment in time. I am pharmacist Huazi. Welcome to follow me and share more health knowledge.